Evaluating Socioeconomic Predictors of Loss to Follow-up in Patients Treated with Hypoglossal Nerve Stimulation

Introduction: Treatment of obstructive sleep apnea (OSA) with hypoglossal nerve stimulation (HGNS) requires routine patient follow-up for device titration, evaluation, and symptom management. This study assesses socioeconomic (SES) predictors for loss to follow-up (LTFU) in HGNS patients, addressing patient demographics and barriers to care.

Methods: A single-institution, retrospective cohort study was conducted for HGNS patients from 2014-2024. LTFU was defined a priori as no documented clinic visit for >1.5 years. Patients were classified as LTFU or not; those with known cause of LTFU (i.e., death, relocation, device explant) were excluded. Covariates included age, sex, insurance type, race, primary language, body mass index (BMI), distance to clinic, national and state Area Deprivation Index (ADI), and comorbidity burden. Continuous variables were compared using Wilcoxon rank-sum tests and categorical variables using Fisher’s exact tests.

Results: Among 608 patients, 288 (47%) met criteria for LTFU. LTFU patients were significantly more likely to be male (71% vs 62%), p=0.013). Additionally, patients who lived farther from the clinic were significantly more likely to be LTFU (p=0.024). Insurance type, race, primary language, ADI, BMI, and comorbidity burden did not differ significantly between groups.

Conclusions: Male sex and greater distance from health centers may identify patients who are at an increased risk of being lost to follow-up. The absence of traditional SES barriers observed in CPAP-treated OSA may reflect the insurance and access requirements inherent to HGNS candidacy, suggesting SES selection may occur prior to implantation rather during follow-up. These results highlight the need for future multicenter studies to direct patient outreach resources both before and after implantation.